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During a busy day, the nurse admits all of the following patients to the medical-surgical unit. Which patients are most important to refer to the dietitian for a complete nutritional assessment?
- A. A 24-year-old who has a history of weight gains and losses
- B. A 53-year-old who complains of intermittent nausea for the past 2 days
- C. A 66-year-old who is admitted for debridement of an infected surgical wound
- D. A 45-year-old admitted with chest pain and possible myocardial infarction (MI)
- E. A 32-year-old with rheumatoid arthritis who takes prednisone daily
Correct Answer: A,C,E
Rationale: Weight fluctuations, use of corticosteroids, and draining or infected wounds all suggest that the patient may be at risk for malnutrition. Patients with chest pain or MI are not usually poorly nourished. Although vomiting that lasts 5 days places a patient at risk, nausea that has persisted for 2 days does not always indicate poor nutritional status or risk for health problems caused by poor nutrition.
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The nurse is caring for a patient and notes that the peripheral parenteral nutrition (PN) bag has only 20 mL left and a new PN bag has not yet arrived from the pharmacy. Which of the following interventions is priority?
- A. Monitor the patient's capillary blood glucose until a new PN bag is hung.
- B. Flush the peripheral line with saline and wait until the new PN bag is available.
- C. Infuse 5% dextrose in water until the new PN bag is delivered from the pharmacy.
- D. Decrease the rate of the current PN infusion to 10 mL/hour until the new bag arrives.
Correct Answer: C
Rationale: To prevent hypoglycemia, the nurse should infuse a 5% dextrose solution until the next PN bag can be started. Decreasing the rate of the ordered PN infusion is beyond the nurse's scope of practice. Flushing the line and then waiting for the next bag may lead to hypoglycemia. Monitoring the capillary blood glucose is appropriate but is not the priority.
Which of the following actions should the nurse take first in order to improve calorie and protein intake for a patient who eats only about 50% of each meal because of 'feeling too tired to eat much'?
- A. Teach the patient about the importance of good nutrition
- B. Serve multiple small feedings of high-calorie, high-protein foods.
- C. Obtain an order for enteral feedings of liquid nutritional supplements.
- D. Consult with the health care provider about providing parenteral nutrition (PN).
Correct Answer: B
Rationale: Eating small amounts of food frequently throughout the day is less fatiguing and will improve the patient's ability to take in more nutrients. Teaching the patient may be appropriate, but will not address the patient's inability to eat more because of fatigue. Tube feedings or PN may be needed if the patient is unable to take in enough nutrients orally, but increasing the oral intake should be attempted first.
After 6 hours of parenteral nutrition (PN) infusion, the nurse checks a patient's capillary blood glucose level and finds it to be 6.7 mmol/L. Which of the following actions should the nurse take?
- A. Obtain a venous blood glucose specimen.
- B. Slow the infusion rate of the PN infusion.
- C. Recheck the capillary blood glucose in 4 hours.
- D. Notify the health care provider of the glucose level.
Correct Answer: C
Rationale: Mild hyperglycemia is expected during the first few days after PN is started and requires ongoing monitoring. Because the glucose elevation is small and expected, notification of the health care provider is not necessary. There is no need to obtain a venous specimen for comparison. Slowing the rate of the infusion is beyond the nurse's scope of practice and will decrease the patient's nutritional intake.
The nurse is caring for a patient with protein calorie malnutrition who has had abdominal surgery and is receiving parenteral nutrition (PN). Which of the following findings is the best indicator that the patient is receiving adequate nutrition?
- A. Blood glucose is 6.1 mmol/L.
- B. Serum albumin level is 35 g/L.
- C. Fluid intake and output are balanced.
- D. Surgical incision is healing normally.
Correct Answer: D
Rationale: Because poor wound healing is a possible complication of malnutrition for this patient, normal healing of the incision is an indicator of the effectiveness of the PN in providing adequate nutrition. Blood glucose is monitored to prevent the complications of hyperglycemia and hypoglycemia, but it does not indicate that the patient's nutrition is adequate. The intake and output will be monitored but do not indicate that the PN is effective. The albumin level is in the low-normal range but does not reflect adequate caloric intake, which is also important for the patient.
Which of the following actions should the nurse implement when using a soft, silicone nasogastric tube for enteral feedings?
- A. Avoid giving medications through the feeding tube.
- B. Flush the tubing after checking for residual volumes.
- C. Administer continuous feedings using an infusion pump.
- D. Replace the tube every 3-5 days to avoid mucosal damage.
Correct Answer: B
Rationale: The soft silicone feeding tubes are small in diameter and can easily become clogged unless they are flushed after the nurse checks the residual volume. Either intermittent or continuous feedings can be given. The tubes are less likely to cause mucosal damage than the stiffer polyvinyl chloride tubes used for nasogastric suction and do not need to be replaced at certain intervals. Medications can be given through these tubes, but flushing after medication administration is important to avoid clogging.